Basic Information
| Provider Information | |||||||||
| NPI: | 1245385152 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SILVA | ||||||||
| FirstName: | JASON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4601 PARK RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282092290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043232256 | ||||||||
| FaxNumber: | 7049457681 | ||||||||
| Practice Location | |||||||||
| Address1: | 710 PARK CENTER DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | MATTHEWS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281055082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043233200 | ||||||||
| FaxNumber: | 7043233204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 09/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 2012-00101 | NC | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1245385152 | 05 | NC | MEDICAID | NC1542 | 05 | SC | MEDICAID |